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Serial Casting Before Relapse Surgery: Investigating the Challenges of Relapsed Clubfoot Care
Kahlia Hay1,2, Noula Gibson1,2, Dominic Knight2
1Physiotherapy, Perth Children's Hospital.
Insights
Presurgical casting for relapsed clubfoot significantly reduced surgical complexity compared to no casting. This approach may lessen the need for complex surgeries in children with recurrent clubfoot.
Area of Science:
- Pediatric Orthopedics
- Congenital Limb Deformities
Background:
- Clubfoot is a common congenital condition treated with the Ponseti method.
- Relapse occurs in up to 40% of cases, often necessitating surgery.
- The role of presurgical casting before relapse management is not well-defined.
Purpose of the Study:
- To evaluate if presurgical casting reduces the number and complexity of surgeries for relapsed clubfoot in children under 16.
- To compare surgical outcomes between children with relapsed clubfoot who received presurgical casting and those who did not.
Main Methods:
- Retrospective cohort audit of children surgically treated for relapsed clubfoot (2015-2024) after initial Ponseti management.
- Participants were divided into groups based on receiving presurgical casting or not.
- Primary outcomes were the number and complexity of surgical procedures.
Main Results:
- The presurgical casting group showed a 40.0% reduction in surgical complexity versus 1.9% in the noncasting group (P=0.001).
- High-complexity surgeries were less frequent in the casting group (53.3%) compared to the noncasting group (80.6%) (P=0.004).
- Noncompliance with orthosis use was noted, and Indigenous children were overrepresented in the relapse cohort.
Conclusions:
- Presurgical casting may decrease the surgical burden for relapsed clubfoot.
- This evidence can inform clubfoot service development and treatment strategies for relapsed cases.
Background:
Clubfoot is a common congenital condition typically treated in infancy using the Ponseti method. Despite successful initial treatment, relapse occurs in up to 40% of cases and often requires surgical management. While serial casting is widely used for initial correction, its utility before surgical relapse management remains unclear. This study evaluates whether presurgical casting is associated with a reduction in the number and complexity of surgical procedures for relapsed clubfoot in children under the age of 16 years.
Methods:
A retrospective cohort audit conducted at a tertiary treatment center reviewed children treated surgically for relapsed clubfoot between 2015 and 2024 following initial Ponseti management. Data were extracted from medical records, and participants were stratified into 2 groups: those who received presurgical casting and those who did not. Primary outcomes included the number and complexity of procedures.
Results:
Sixty-five participants were included: 14 (21.5%) received presurgical casting. The casting group demonstrated a 40.0% reduction in surgical complexity from waitlist to surgery, while the noncasting group showed only a 1.9% reduction (P=0.001). High-complexity surgeries were less common in the casting group (53.3% compared with the noncasting group, 80.6%, P=0.004). Noncompliance with orthosis use was common, and Indigenous children were overrepresented in the relapse cohort.
Conclusion:
Presurgical casting may reduce the surgical burden in relapsed clubfoot.
Level Of Evidence:
The retrospective comparative study provides a comparison between presurgical casting and noncasting, providing evidence to guide clubfoot service development.